Catholic Health Initiatives Analyst, Payment Transformation in ENGLEWOOD, Colorado

Analyst, Payment Transformation

Description

Analyst, PaymentTransformation

The Analyst of Payment Transformation provides operational,

analytical and pricing expertise for the evaluation,

negotiation, implementation and maintenance of value-based contracts between CHI providers and payers. Provides

value-based program management activities. Supports

strategies for maximizing value-based contract

reimbursement and value. Performs complex financial analysis and modeling of value-based

contract reimbursement levels and methodologies.

ESSENTIAL KEY JOB RESPONSIBILITIES

  1. Act as a subject matter expert and liaison across CHIfunctional areas related to participation and performance of value-basedprograms and payment models.

  2. Provide program management support for CHI’sparticipation in value-based programs (program research, applicationprocedures, compliance activities, education, reporting, etc.).

  3. Maintain knowledge of industry trends, payer policiesand protocols, and program guidelines related to value-based programs andpayment models.

  4. Monitor value-based contract financialperformance. Analyze performance statements and determineprofitability. Review and accurately interpret contract terms, includingdevelopment of policies and procedures in support of contract evaluation.

  5. Conduct modeling of proposed/existing value-based payercontracts, including expected and actual revenues/volumes, pastperformance, proposed contract language and regulatory changes.

  6. Analyze terms of new and existing risk and non-riskcontracts and/or amendments/modifications using approved model contractlanguage.

  7. Support complex service line reimbursement analyses andfinancial performance analyses. Develop methods and prepare complexfinancial reimbursement analyses and models (involving multiple variablesand assumptions) to identify the implications/ramifications/results of awide variety of new/revised strategies, approaches, provisions, parametersand rate structures aimed at establishing appropriate value-basedreimbursement terms.

  8. Identify, collect, and manipulate data from a widevariety of financial and clinical sources (e.g., EPSI, PIC, Epic) andexternal sources (e.g., Medicare/Medicaid website, Medicare claimfiles). Identify and access appropriate data resources to supportanalyses and recommendations. Identify risk/exposure with variousreimbursement structure options.

  9. Maintain knowledge of operations sufficient to identifycausative factors, deviation, allowances that may affect reportingfindings.

  10. Prepare routine reports and ad-hoc analyses asdirected, with ability to accurately reflect actual performance trends andprojections.

Qualifications

Required Minimum Knowledge, Skillsand Abilities

  • 2-5 years experience in processing or analyzing health insurance claims either from a provider or payer standpoint.

  • Very strong skills in either MS Excel, Access, or SQL.

  • Strong background in financial analysis is required. Managed care and value-based contract knowledge preferred.

  • Knowledge of healthcare coding principles preferred (e.g.,ICD-10, HCPCS, DRG).

  • Must be able to lead and coordinate projects through various complex andchallenging situations to completion under time-sensitive deadlines.

  • This position provides a critical liaison and negotiating arm for CHI hospitalsand physicians, which has a profound impact on the organization.

  • This position will serve all stakeholders through on-going educational andproblem-solving support.

  • Requires daily contact with senior management, physician, hospital staff, andmanaged care company leaders

  • This person must take accountability for designated reimbursement modules andsystems and must be proficient in readying, interpreting and formulatingcomplex computer system rules.

  • The position must handle adverse and politically difficult situations, as value-based contracts have a direct impact on individual physician incomes,along with directly impacting the financial performance of CHI.

  • Bachelor’s Degree in BusinessAdministration, Finance, Healthcare or related field required or equivalentexperience preferred.

Job Professional Non-Clinical

Primary Location COLORADO-ENGLEWOOD-DENVER INVERNESS

Daily Schedule M-F

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0165027

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.